Physician Home Visit Program Builds Relationships, Improves Access to Care

April 16, 2018
By: NHRMC
Raines blog photo main
After the team of three physicians and a pharmacist greet patient Rita Raines in her living room, Dr. Toren Davis kneels to pet Poppy, her protective Chihuahua clad in a striped sweater.

As Poppy adjusts to their presence and calms down, Dr. Davis says “Oh, we’re best friends now.”

Getting to know pets is just part of what’s different about doctors making house calls. The New Hanover Regional Medical Center - Coastal Family Medicine home visit clinic launched in 2015 as a residency project focused on barriers to care in the community. A big one was transportation.

“Taking the clinic and coming to them eliminates that barrier,” said Dr. Davis, medical director and faculty physician at Coastal Family.

Raines, who relies on a motorized wheelchair to safely get around her home, has participated in the clinic for about three years.

“It makes it a lot easier on me when they come to me because I don’t drive,” she said.

The clinic, which serves about 20 patients in the region at a time, focuses on those like Raines with transportation challenges or repeat visitors to the emergency room.

“The distance between home and the clinic is a huge reason for people not being able to come to the doctor and get the medical care they need,” Dr. Davis said. “A lot of times that leads to decreased care and emergency room visits and hospitalizations.”

Since 2017, patients enrolled in the program have had a 70 percent reduction in emergency room use and a 40 percent reduction in hospital admissions.

But the clinic doesn’t just aim to keep people out of the hospital – it is about increasing access to care. Before the program, patients were seen an average of one time a year in the doctor’s office because of transportation issues. With the clinic, they are seen four to six times a year.

Raines’ regular appointment has hallmark signs of a typical doctor’s visit – Dr. Mariam Nejati, a second-year resident – listens to her breathing and takes her blood pressure.

Yet the care team works together to address other issues.

When Raines reports a need to replace her aging motorized wheelchair, Dr. Davis kneels to inspect the tires and sees they are thin. He assures her they will work on that and follow up with her.

After Raines tells them it will be almost impossible to come to the lab for bloodwork, the team works on a plan to have a nurse come to her home.

But it’s not all business.

Raines talks about listening to music, watching history channels to learn about the past, and discusses a painting of her dad on vacation years ago in Fort Fisher.

Dr. Davis stresses the importance of seeing the whole person in their living environment – a good teaching opportunity for the residents.

“It’s very hard to see the full picture of someone in 15 minutes in the clinic,” Dr. Davis said. “In a lot of these home visits you’re able to connect with those patients quite a bit more than just going over diagnoses. You really are able to touch base and see a lot of the social aspect of medicine – a lot of where they’re from, their family, the things that are important to them at home.”

Raines enjoys the visits. They remind her of when she was a little girl and the doctor would come see her and her siblings at the house.

“I feel like I’ve become friends with them more than a patient-doctor relationship,” she said. “I know we still have that, but I also feel like I’ve made a bunch of friends over there.”

Categories: Patient Stories
Albert Meyer - May 08, 2018
Very proud of the Coastal Family Medicine Team making health care truly patient centered
Cynthia collins - June 03, 2018
Where is this visit documented in epic. Is there an order for these visits?

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